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CMS Approves California Advancing and Innovating Medi-Cal (CalAIM) Proposal

CalAIM is part of a commitment to make Medi-Cal more equitable, coordinated, and person-centered

January 10, 2022 – The Centers for Medicare & Medicaid Services (CMS) approved the California Department of Health Care Services’ (DHCS’) request for a five-year extension of its Medicaid section 1115 demonstration and a five-year extension of its Medicaid managed care section 1915(b) waiver. The 1915(b) waiver was renamed California Advancing and Innovating Medi-Cal (CalAIM).

This far-reaching and multi-year plan is designed to help integrate health care more seamlessly with other social services that can improve overall health outcomes. The first reforms will start to be implemented in January 2022 and will be phased in over time through 2027.

CalAIM Design to Improve Medi-Cal

Medi-Cal is California’s Medicaid program. Currently, Medi-Cal covers approximately one-third of Californians, including over half of school-aged children. The federal approval of CalAIM will shift Medi-Cal to a population health approach. 

This new approach will prioritize equitable and person-centered care that addresses social drivers of health. Key provisions of the CalAIM initiatives include: 

  • Community Supports
  • Enhanced Care Management 
  • Delivery System Transition and Alignment 
  • Providing Access and Transforming Health (PATH) Supports
  • Substance Use Disorder Services and Initiatives 
  • Supporting Coordination and Integration for Dual Eligibles
  • Dental Benefits
  • Chiropractic Services for Indian Health Service and Tribal Facilities
  • Global Payment Program 

The goal of CalAIM is to make services more standardized and equitable across the state, ensure that those who need help can actually get it, and implement payment reform by incorporating value-based payment models. 

CalAIM Receives Strong Support From CMS

One of the big priorities of CalAIM is extended programs that create an easier pathway for individuals to receive care outside of traditional health care settings. The proposal provides $4.3 billion in total funding for California’s HCBS program. This aligns strongly with CMS’ support of healthcare at home and allowing individuals to age comfortably and safely at home. As such, the program has received strong support from CMS.

“CalAIM will advance health equity in California and strengthen the health care safety net,” said CMS Administrator Chiquita Brooks-LaSure. “We appreciate the strong partnership with California to create pathways for people with Medi-Cal to more easily access equitable, comprehensive care.”

To read the CMS approval letter to California to renew its 1915b waiver and learn more about CalAIM, please click here.

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